Publication of the first Australian Atlas of Healthcare Variation has confirmed significant variability in utilisation of pharmaceuticals across Australia.
The report prepared by the Australian Commission on Safety and Quality in Health Care, reveals significant variability in the dispensing of psychotropic medicines for children and adolescents 17 years and under.
"More than 500,000 prescriptions were dispensed for attention deficit hyperactivity disorder medicines in Australia in 2013-14," it says, highlighting the fact that the number of prescriptions per 100,000 people in the area with the highest rate was 75 times higher than in the area with the lowest rate.
In relation to the use of antidepressants, for which Australia ranks second amongst OECD countries, the report says nearly 15 million PBS-funded prescriptions for antidepressant medicines were dispensed for people aged 18 to 64.
More than 900,000 prescriptions for antipsychotic medicines were dispensed for people aged 65 and over, with the number of prescriptions seven times higher in the area with the highest rate compared to the area with the lowest rate.
The PBAC and its Drug Utilisation Sub Committee have already expressed concern over the high and what they believe to be the inappropriate prescribing of antipsychotic medicines in older people.
"These medicines may be prescribed outside guideline recommendations, such as for behavioural disturbances related to dementia or delirium, before secondary causes have been excluded and non-pharmacological measures have been tried," says the new report.
The report also points to significant variation in the use of PBS-listed medicines for Alzheimer's disease (anticholinesterase medicines).
"The number of prescriptions dispensed for anticholinesterase medicines for people aged 65 and over was more than 15 times higher in the areas with the highest rate compared to the area with the lowest rate," it says.
The report also highlights variations in the dispensing of prescription opioids.
"In 2013-14, nearly 14 million prescriptions were dispensed through the PBS for opioid medicines. The number of prescriptions dispensed was 10 times higher in the area with the highest rate compared to the area with the lowest rate. There is no apparent explanation for this, although the availability of other options for treatment of non-cancer pain may be a factor," it says.
According to the report, while some variation is expected – it reflects differences in people’s need for health care, underlying differences in the health of specific populations, or personal preferences - it also means people are missing out or others are having interventions that are unlikely to be of benefit.
"The weight of evidence in Australia and internationally suggests that much of the variation documented in the atlas is likely to be unwarranted. The challenge is to improve the appropriateness of care," it says. "We know that overuse of some interventions may cause harm."
